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Johann Trutz, Aurel Babeș and Katalin Babeș

Abstract

Background and Aims. Several factors are associated with a heightened risk of subsequent events, morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) after an acute coronary syndrome (ACS). Improving the management of these patients is a challenge that requires urgent attention. We aimed to study the long-term effect of the change in treatment strategy depending on the HbA1c level detected during the hospitalization for ACS. Material and methods. The primary endpoints of this study were the major adverse cardiac events (MACE) at 12 months. From the originally included 221 patients 15 were lost (no response to follow-up phone calls). The suboptimal glycaemic control group (HbA1c>7.0%, n=84) was divided in two subgroups: patients who completed a diabetological consult with further treatment changes (intervention group) and patients without this referral (control group). Results. No significant differences in baseline characteristics were found between the 2 subgroups. The second subgroup had a triple risk for a MACE in 1 year (HR=2.8704, 95% CI: 1.109-7.423, p=0.0296) compared to the intervention group. No significant differences were found in secondary endpoints. Conclusion. This study suggests that, after hospitalization for an ACS, diabetologist referral and treatment strategy changes are recommended for all T2DM patients whose HbA1c level is over 7% before discharge.

Open access

Nikolay G. Dimitrov, Iana I. Simova, Hristo F. Mateev, Maria R. Kalpachka, Pavlin S. Pavlov and Iveta G. Tasheva

Guidelines for the management of acute coronary syndrome in patients presenting without persistent ST segment elevation. The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2999-3054. 5. Neumann FJ, Kastrati A, Pogatsa-Murray G, et al. Evaluation of prolonged antithrombotic pretreatment (“cooling-off” strategy) before intervention in patients with unstable coronary syndromes: a randomized controlled trial. JAMA 2003

Open access

Józef Bergier, Ewelina Niźnikowska, Barbara Bergier, Pongrac Acs, Ferdinand Salonna and Jan Junger

V, Holmen TL, Kurtze N, Cuypers K, Midthjell K. Reliability and validity of two frequently used self-administered physical activity questionnaires in adolescents. BMC Med Res Methodol. 2008;8:47; doi: 10.1186/1471-2288-8-47. 24. Janssen I, Leblanc A. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7:40; doi: 10.1186/1479-5868-7-40. 25. Ács P, Hécz R, Paár D, Stocker M. Physical inactivity and the national economy in Hungary. Közgazdasági

Open access

Valeria Ács, Hajnal Finta, Edith Simona Ianosi and Monica Sabău

Abstract

Aim: Evaluation of the contribution of general practitioners to the early diagnosis of tuberculosis in the studied period. Analysis of cases not diagnosed as active TB, from those suspected by the general practitioner and the real cases with respiratory lesions.

Material and methods: We conducted an observational epidemiologic study aiming at evaluating the diagnosis of pulmonary TB at the level of primary care medicine.

Results: The difference between conformed TB patients that have been referred with the suspicion of TB and those without suspicion is significant (p <0.0001), and the risk of disease estimated by OR was 21.54. More than half of the patients (139), had positive microscopic examination and culturing, representing 62.61%. In 10.36% microscopic examination was positive and culturing was negative (13 patients). Negative microscopic examination and positive culturing were detected in 5.86% of the patients. The majority of suspected/confirmed new patients were living in urban environments. The urban/rural ratio was 1.27. The reasons why the general practitioner suspected tuberculosis, in the order of frequency, were the following: cough/dry cough, sweating/nocturnal sweating, fever/persisting fever. Among the TB types, we noted the large percentage of patients with infiltrating, nodular tuberculosis confined to the volume of one pulmonary segment (30.78%), and 19.87% of the cases were multicavity tuberculosis; also, we noted the presence of caseous tuberculosis with moderate volumes of infiltrates, confined to a pulmonary lobe (18.27%).

Conclusion: Early diagnosis of tuberculosis in the primary healthcare network is a continuous challenge for the general practitioner.

Open access

Xiao-huan Gong, Jin-ming Yu, Yong Mao and Da-yi Hu

Introduction Acute coronary syndrome (ACS) encompasses unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STE-MI). UA and NSTE-MI are classified as non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Life-threatening NSTE-ACS is a leading cause of emergency and hospitalization in the United States. [ 1 ] It causes a lot of public expenditures. Its cost might account for a large proportion of worldwide health care expenditures in the future. [ 2 ] The basic medicine for

Open access

Raina G. Ardasheva, Mariana D. Argirova, Valentin I. Turiiski and Athanas D. Krustev

Abstract

Background: Increased intra-abdominal pressure (IAP) causes tissue ischemia, subsequent hypoxia, and impairment of normal tissue metabolism. Elevation of IAP above 20 mmHg leads to progression of abdominal compartment syndrome (ACS) that is associated with organ dysfunction or failure not previously manifested. Aim: To evaluate the eff ects of diff erent grades and time of exposure to IAP on biochemical parameters and oxidative stress in organs aff ected by ischemia using previously developed rat model. Results: Three experimental groups exposed to diff erent IAP and time frames were tested for liver, kidney, and pancreas injury by measuring the activities of tissue specifi c enzymes in blood serum. Elevated activities of aspartate aminotransferase, pancreatic amylase, lipase, and higher concentrations of D-lactate, urea, and creatinine were found in some of the experimental groups compared to a control group of animals not subjected to increased IAP. Increased levels of biomarkers of oxidative stress as well as decrease in concentration of the major cellular antioxidant glutathione indicated the presence of oxidative injury as a result of elevated IAP. Conclusions: The developed rat model is appropriate to study the mechanism and manifestation of tissue injury during diff erent grades of elevated IAP but also to test approaches aimed to attenuate the detrimental eff ects of ACS. This study also underlines the necessity of using not a single but a set of biochemical parameters in order to assess the severity of tissue injury during elevated IAP and progression to ACS.

Open access

Jakó Beáta, Benedek Theodora, Suciu Zsuzsanna and Benedek I

Abstract

Introduction: The association between a high calcium score at the level of the unstable coronary lesions and the different characteristic of culprit lesions which result in an acute coronary syndrome (ACS) has not been described yet. We aimed to study the correlation between the accumulation of calcium within the vessel wall of a coronary artery and the plaque burden of culprit lesions that develop an acute coronary event. Material and methods: A total of 45 patients with ACS (22 unstable angina, 23 nonST elevation myocardial infarction) underwent 64-slice CCTA. In all patients a complex CT analysis of the culprit plaques was performed and the calcium score for each coronary artery was computed. Results: We found a significant correlation between a calcium score higher than 100 and the plaque volume (r = 0.85. p = 0.01). Selecting a cut-off value of 100 HU for regional calcium score at the level of the coronary artery, we found that those arteries with Ca score higher than 100 presented significantly larger plaque volumes than the ones with calcium score below 100 (110.8 ml vs 82.4 ml, p <0.0001 for left anterior descending artery, 111.09 ml vs 82.5 ml, p = 0.0005 for circumflex artery, and 132.78 ml vs 76.23 ml for right coronary artery). Conclusion: Our data shows that in ACS, the severity of the culprit lesions correlates with regional accumulation of calcium within the vessel wall.

Open access

Jakó Beáta, Benedek Theodora, Suciu Zsuzsanna and Benedek I

Abstract

Introduction: Coronary calcium score, as determined by Angio CT multislice, has been proved to represent a reliable parameter which reflects the global cardiovascular risk. We aimed to study the characteristics of culprit lesions in Acute Coronary Syndrome (ACS) patients with low versus high calcium score. Material and methods: A total of 45 patients with ACS underwent 64-slice CCTA. Group 1 - 19 patients with Ca score below 400HU, Group 2 - 26 patients with calcium score >400HU. In all patients a complex CT analysis of the culprit plaque was performed. Results: There were no significant differences between the groups at baseline as regard to age, gender, cardiovascular risk factors (p>0.2). In patients with high calcium score, culprit lesions presented a significantly larger amount of plaque burden than in patients with low calcium score (82.8ml versus 131.81ml, p <0.0001). This was also true when assessing in a subanalysis different cut-off points for definition of relatively higher calcium score (89.66ml versus 137.93ml, p <0.0001, for calcium score cut off 600HU, 97.88ml versus 137.57ml, p<0.0001 for calcium score cut-off of 1000HU). Conclusion: Our data shows that patients with high calcium score who develop an acute coronary syndrome present larger atheromatous plaque than those with low calcium scores, and theseverity of the culprit lesions correlates with global cardiovascular risk as expressed by a high calcium score

Open access

Zeynep Yildiz, Abdulkadir Koçer, Şahin Avşar and Göksel Cinier

:329-65. 5. Hamm Cw., Bassand Jp., Agewall S., Bax J. Esc Committee For Practice Guidelines. Esc Guidelines For The Management Of Acute Coronary Syndromes In Patients Presenting Without Persistent St-Segment Elevation: The Task Force For The Management Of Acute Coronary Syndromes (Acs) In Patients Presenting Without Persistent St-Segment Elevation Of The European Society Of Cardiology (Esc). Eur Heart J. 2011; 32:2999-3054. 6. Kerr G., Ray G., Wu O., Stott Dj., Langhorne P. Elevated Troponin After Stroke: A Systematic Review. Cerebrovasc Dis. 2009; 28

Open access

A. Tascu and Simona Mihaela Florea

Abstract

Background: There are yet to clarify some aspects regarding the surgical indications and surgical methods that are at choice for treating ACs. The purpose of the study is to contribute to the ongoing debate on the most appropriate treatment.

Materials and methods: We included in the study 44 pediatric patients (aged < 18 years), operated for ACs in the Neurosurgery I Department, of the Emergency Clinical Hospital “Bagdasar- Arseni” in Bucharest, during the period January 2003 to December 2012. The surgical methods were either a craniotomy or cyst shunting. The information regarding these patients was retrospectively assessed based on their clinical and imaging records, and cross checked with the OR protocols. Treatment efficiency was evaluated considering postoperative clinical status, imaging appearance and postoperative complications.

Results: 84.1% of the patients reported postoperative disappearance or reduction of symptoms, while 13.6 had the same complaints as prior surgery. Only one patient experienced worsening of symptoms. Follow-up imaging showed cyst disappearance in 29.5% patients and cyst reduction in 61.4% patients. 9.1% had no change in cyst volume. Craniotomy correlated with a better imaging appearance (p=0.02). There was no correlation between improved clinical status and cyst fluid reduction (p=0.6). 9 patients (20.4%), all with temporal cysts, experienced postoperative complications, and 7 of them (15, 9%) needed surgery. There was no severe or permanent dysfunction in any of the patients. 42.8% of the cyst shunting patients suffered postoperative complications, whereas only 10% of the craniotomy patients did.

Conclusion: Cyst decompression results in significant clinical improvement and it can be performed with little risk for severe complications. Craniotomy seems to be a better surgical treatment option than cystoperitoneal shunt, with a better neuroimaging appearance and a lower complications rate